Norepinephrine Infusion in the Emergency Department in Septic Shock Patients: A Retrospective 2-Years Safety Report and Outcome Analysis

Antonio Messina, Angelo Milani, Emanuela Morenghi, Elena Costantini, Stefania Brusa, Katerina Negri, Daniele Alberio, Ornella Leoncini, Silvia Paiardi, Antonio Voza and Maurizio Cecconi
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Antonio Messina: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Angelo Milani: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Emanuela Morenghi: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Elena Costantini: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Stefania Brusa: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Katerina Negri: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Daniele Alberio: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Ornella Leoncini: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Silvia Paiardi: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Antonio Voza: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy
Maurizio Cecconi: Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milano, Italy

IJERPH, 2021, vol. 18, issue 2, 1-9

Abstract: Hemodynamic optimization during sepsis and septic shock is based on a prompt and large fluid resuscitation strategy associated with early administration of norepinephrine. In our hospital, norepinephrine is administered in the emergency department (ED), within a protocol-guided management context, to reduce norepinephrine infusion timing due to central line insertion. This choice, however, can be associated with side effects. Objectives: We conducted a retrospective analysis regarding the safety of norepinephrine in the ED. We also appraised the association between in-hospital mortality and predefined ED variables and patients’ admission severity scores. Design, settings, and participants: This was a retrospective analysis of electronic sheets of the ED of a tertiary hospital in the North of Italy. Outcomes measure and analysis: Electronic documentation was assessed to identify local and systemic side effects. We considered two subgroups of patients according to the in-hospital clinical paths: (1) those admitted in the intensive care unit (ICU); and (2) those who received a ceiling of care decision. We collected and considered variables related to septic shock treatment in the ED and analyzed their association with in-hospital mortality. Main Results: We considered a two-year period, including 108,033 ED accesses, and ultimately analyzed data from 127 patients. Side effects related to the use of this drug were reported in five (3.9%) patients. Thirty patients (23.6%) were transferred to the ICU from the ED, of whom six (20.0%) died. Twenty-eight patients (22.0%) received a ceiling of care indication, of whom 21 (75.0%) died. Of the 69 (54.3%) finally discharged to either medical or surgical wards, 21 (30.4%) died. ICU admission was the only variable significantly associated to in-hospital mortality in the multivariable analysis [OR (95% CI) = 4.48 (1.52–13.22); p -value = 0.007]. Conclusions: Norepinephrine peripheral infusion in the ED was associated with a low incidence of adverse events requiring discontinuation (3.9%). It could be considered safe within <12 h when a specific line management protocol and pump infusion protocol are adopted. None of the variables related to septic shock management affected in-hospital mortality, except for the patient’s ICU admission.

Keywords: norepinephrine; emergency department; septic shock (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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